Beyond Hospital Boundary: A Novel Game-Changer Tool of Kayakalp for Community Participation in Sanitation, Hygiene, and
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affordable, easily available, orally administered and not needing any specific monitoring for side effects. After remission, we omitted montelukast first because we believed that cetirizine has a better safety profile for long term use.
After a extensive literature search [2-4] and detailed discussion with parents, we commenced a combination of oral cetirizine (0.29 mg/kg/day) and oral montelukast (0.58 mg/kg/ day). We witnessed a rapid and sustained clinical response.
Thus, while earlier reports suggest variable effect of cetirizine and montelukast in this disease, the dramatic response to these drugs suggests that inhibition of eosinophil recruitment and activity may be an important aspect in the treatment of Kimura disease.
Kimura disease usually has an indolent course. The etiology remains unclear, although eosinophilia, increased IgE, tumor necrosis factor (TNF-α), interleukin (IL)-4, IL-5, IL-13 and mast cells are seen in the peripheral blood and tissue, leading to autoimmunity, allergy, neoplasm and parasite infestation being proposed as possible risk factors [5]. In localized disease, surgery is the mainstay of therapy. Regional or systemic corticosteroid therapy, immunosuppressive agents and radiation have been used [1]. Recurrences after surgery or on discontinuing steroid treatment are common [1]. Other agents tried with variable outcomes are oxpentifylline, cryotherapy, vinblastin, all-trans-retinoic acid and Imatinib [5].
PALLAVI PIMPALE CHAVAN1*, SR KHUBCHANDANI2 AND RP KHUBCHANDANI1 1Department of Pediatric Rheumatology, SRCC Children’s Hospital; and 2Surgical Pathologist and Electron Microscopist, Jaslok Hospital and Research Centre; Mumbai, Maharashtra, India. *[email protected] REFERENCES 1. Xu X, Fu J, Fang Y, Liang L. Kimura disease in children: A case report and a summary of the literature in Chinese. J Pediatr Hematol Oncol. 2011;33:306-11. 2. Ben-Chetrit E, Amir G, Shalit M. Cetirizine: An effective agent in Kimura’s disease. Arthritis Care Res. 2005;53:117-8. 3. Okami K, Onuki J, Sakai A, Tanaka R, Hagino H, Takahashi M. Sleep apnea due to Kimura’s disease of the larynx: Report of a case. Orl. 2003;65:242-4. 4. Gurram P, Chandran S, Parthasarathy P, Thiagarajan MK, Ramakrishnan K. KIMURA’S disease – An E[X]clusive condition. Ann Maxillofac Surg. 2019;9:183-7. 5. Sun QF, Xu DZ, Pan SH, Ding JG, Xue ZQ, Miao CS, et al. Kimura disease: Review of the literature. Intern Med J. 2008;38:668-72.
Cetirizine, a selective histamine H1 receptor blocker is known for its antihistaminic and anti-inflammatory properties. It inhibits eosinophil chemotaxis, adhesion to endothelial cells, suppresses the generation of various proinflammatory cytokines and decreases intercellular adhesion molecule 1 expression [2]. Pranlukast and montelukast are leukotriene receptor antagonists known for their anti-inflammatory role [3]. Almost all the previous reports on these two drugs were in middle aged adult patients with Kimura disease, reflecting the disease demography, with little data on use of these safer
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